Provider Demographics
NPI:1205605631
Name:ALLIANCE FOOT AND ANKLE CLINICS, LLC
Entity type:Organization
Organization Name:ALLIANCE FOOT AND ANKLE CLINICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:JON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-282-7209
Mailing Address - Street 1:6510 W LAYTON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4563
Mailing Address - Country:US
Mailing Address - Phone:414-282-7209
Mailing Address - Fax:414-282-9948
Practice Address - Street 1:6123 GREEN BAY RD STE 260
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-2939
Practice Address - Country:US
Practice Address - Phone:262-731-0077
Practice Address - Fax:414-282-9948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric